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Surgical risk assessment for super-elderly patients
Yasuaki Miura1, Kenji Nishio1, Yohei Kitamura1
1Department of Surgery, Minami-Machida Hospital, Tokyo, Japan.
Geriatrics & Gerontology International
|February 4, 2022
Summary
A new SAP score combining skeletal muscle mass index and American Society of Anesthesiologists physical status effectively predicts surgical outcomes in super-elderly patients. This tool aids in informed consent for patients over 90 years old.
Area of Science:
- Geriatric Medicine
- Surgical Risk Assessment
- Anesthesiology
Background:
- Super-elderly patients (>90 years) present unique challenges for surgical decision-making due to frailty.
- Accurate preoperative risk assessment is crucial for optimizing outcomes and informed consent in this population.
Purpose of the Study:
- To develop and validate a preoperative surgical risk assessment tool for super-elderly patients.
- To identify key determinants of postoperative outcomes in patients aged over 90 years.
Main Methods:
- 112 patients aged >90 years undergoing surgery under general anesthesia were analyzed.
- Patients were categorized into good and poor postoperative outcome groups.
- Evaluated parameters included American Society of Anesthesiologists (ASA) physical status, skeletal muscle mass index (SMI), and the Estimation of Physiology Ability and Surgical Stress (EPASS) score.
Main Results:
- The EPASS score correlated with postoperative outcomes (P=0.001), with sensitivity 0.83 and specificity 0.61.
- Multivariate analysis identified SMI and ASA physical status as significant risk determinants.
- The novel "SAP score" (SMI + ASA) demonstrated high predictive value (P<0.001) with sensitivity 0.76 and specificity 0.91.
Conclusions:
- The SAP score, integrating SMI and ASA status, offers a reliable tool for assessing surgical risk in super-elderly individuals.
- Utilizing such risk scores can improve informed consent and potentially reduce suboptimal surgical decisions in this vulnerable group.
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